First-Line Marshall Plan Approach in Persistent Atrial Fibrillation: A Prospective Single-Center Cohort Study

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Electrophysiology Pub Date : 2025-03-24 DOI:10.1111/jce.16650

Antoine Carmaux, Cedric Yvorel, Karim Benali, Cécile Romeyer, Rayan Mohammed, Jean Michel Vovor, Antoine Da Costa

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引用次数: 0

Abstract

Background

Different ablation strategies have been developed for persistent atrial fibrillation (PeAF), but early management is still controversial. In the clinical setting of PeAF, the safety and efficacy of early Marshall plan have not yet been fully studied.

Objectives

Our prospective cohort study sought to: (1) assess the safety and feasibility of the thermal Marshall plan (MPA) approach as a first-line therapy in PeAF patients; (2) evaluate its long-term sinus rhythm maintenance efficacy; (3) identify the long-term predictive factors of AF recurrence in PeAF patients after MPA approach.

Methods and Results

Between January 2020 and December 2023, 118 PeAF patients were selected for first intent Marshall plan ablation (MPA). Marshall vein failure occurred in 9/118 patients (7.6%). Accordingly, 109 patients who underwent MPA as first-line therapy were included. After the blanking period of 3 months, 62/109 patients were in sinus rhythm (SR) (57%), 33/109 were in AF (30.2%), 8/109 were in left atrial flutter (AFL) (7.3%), and six were in right AFL (5.5%). Re-ablation was performed in 4/33 patients (12.1%) and cardioversion in 29/33 (87.9%) for patients in AF at 3 months after healing. All patients in AFL at 3 months were re-ablated and all recovered SR. At 12 months postablation, two patients were lost to follow-up (1.8%), 94/107 (87.8%) were in SR and 13/107 had AF recurrence (12.2%). At 21 ± 11 months postablation, 81/107 (75.7%) were in SR at the last control, and 26/107 (24.3%) had AF recurrence. The ablation procedure ratio was 1.17 (109 primo ablation, 18 re-ablation). The only predictive factors of late AF recurrence after first-line PeAF MPA were both left atrial dilatation and low left ventricular ejection fraction (LVEF).

Conclusions

This real-life prospective cohort study showed that de novo MPA in PeAF is feasible, relatively safe, and associated with a high rate of freedom from arrhythmia recurrence during long-term follow-up. The percentage of patients remaining in SR during long-term follow-up was close to 76%. The only predictive MPA failure factors were both left atrial dilatation and low LVEF.

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一线马歇尔计划方法治疗持续性心房颤动：一项前瞻性单中心队列研究。

背景：持续性心房颤动（PeAF）的消融策略不同，但早期治疗仍存在争议。在PeAF的临床环境中，早期马歇尔计划的安全性和有效性尚未得到充分的研究。目的：我们的前瞻性队列研究旨在：(1)评估热马歇尔计划（MPA）方法作为PeAF患者一线治疗的安全性和可行性；(2)评价其长期维持窦性心律的疗效；(3)明确PeAF患者经MPA入路后AF复发的远期预测因素。方法与结果：于2020年1月至2023年12月，选择118例PeAF患者进行首次意向马歇尔计划消融（MPA）。马歇尔静脉衰竭发生率为9/118（7.6%）。因此，109例接受MPA作为一线治疗的患者被纳入研究。空白期3个月后，窦性心律62/109例（57%），房颤33/109例（30.2%），左心房扑动8/109例（7.3%），右心房扑动6例（5.5%）。4/33例（12.1%）AF患者在愈合后3个月进行再消融，29/33例（87.9%）AF患者进行复心。所有AFL患者在3个月时再次消融，所有患者都恢复了SR。消融后12个月，2例患者失去随访（1.8%），94/107例（87.8%）发生SR， 13/107例（12.2%）发生AF复发。在消融后21±11个月，81/107（75.7%）的患者在最后一个对照中出现了SR， 26/107（24.3%）的患者再次发生房颤。消融程序比为1.17（首次消融109例，再消融18例）。一线PeAF MPA术后晚期房颤复发的唯一预测因素是左房扩张和低左室射血分数（LVEF）。结论：这项现实生活中的前瞻性队列研究表明，PeAF患者从头治疗MPA是可行的，相对安全，并且在长期随访期间心律失常复发率高。长期随访期间仍处于SR的患者比例接近76%。预测MPA失效的唯一因素是左心房扩张和低LVEF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.